After laboratory contamination brought about a shortage of American flu vaccine at the beginning of the winter, the US public health authority, the Centers for Disease Control, appointed an ethics panel to knot out allocation problems. Now it seems that these Solomons will have work to do after solving the current crisis. Drug shortages, the New York Times has found, are endemic in the US, even for medicines which limit damage from spinal cord injury, which help premature infants, or which fight systemic bacterial infection.

A Times survey found that many experts complain that America’s unregulated drug market often leads to disruptions in supply. Hospital pharmacists say that they are forced to be crisis managers. One Washington DC pharmacist said that every day he posts a three- page computer list of drugs in short supply. Some shortages last days, others months. There are many reasons: drug company mergers, production problems or even outbreaks of mad cow disease. But the high price of drugs is a significant factor. The cost of warehousing drugs is so high that many pharmacists stock only two or three days supply.

Domestic critics of the US system praise regulated markets in Europe which guarantee availability. But American economists point out that the free market system also encourages innovation. Jonathan Gruber, an economist from MIT, says that the US had given Europe a free ride for decades by letting American patients bear the high costs of drug research. Vulnerability to shortages is part of that system, he argued.

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